The puzzling way that writing heals the body.

I started working for the Red Cross during the Vietnam war  in 1971 and have seen incredible amounts of extreme suffering. Forty-five years later (late 2016) I was still working for the Red Cross, this time in Bangladesh after major flooding and a cyclone. Having seen so much trauma  and been in the thick of death, injury, exploitation and destruction, the constant exposure to the suffering of people in war and natural disasters took its toll on my mind and body. What I discovered early on in my Red Cross career is how writing a diary about the horrific things I had seen, somehow eased the pain. I have kept diaries for over 40 years and they proved incredibly therapeutic for relieving tension, stress, pain and hurt. I would always pick an inspiring place to write my diary and found it had an amazing healing effect. Today I found this article on the BBC website written by Claudia Hammond which somehow coincided and explained a technique I had been using for over 40 years. Have a read of it. It may be helpful.

In 1986 the psychology professor James Pennebaker discovered something extraordinary, something which would inspire a generation of researchers to conduct several hundred studies. He asked students to spend 15 minutes writing about the biggest trauma of their lives or, if they hadn’t experienced a trauma, their most difficult time. 

They were told to let go and to include their deepest thoughts, even if they had never shared these thoughts before. Four days running they did the same thing. It wasn’t easy. Pennebaker told me that roughly one in 20 students would end up crying, but when asked whether they wanted to continue they always did. Meanwhile a control group spent the same number of sessions writing a description of something neutral such a tree or their dorm room.

Studies have shown expressive writing can reduce the amount of times people visit the doctor (Credit: iStock)

Then he waited for six months while monitoring how often the students visited the health centre. The day he saw the results, he left the lab, walked to his friend who was waiting for him in a car and told him he’d found something big. Remarkably, the students who had written about their secret feelings had made significantly fewer trips to the doctor in the subsequent months.

Ever since, the field psychoneuroimmunology has been exploring the link between what’s now known as expressive writing, and the functioning of the immune system. The studies that followed examined the effect of expressive writing on everything from asthma and arthritis to breast cancer and migraines. In a small study conducted in Kansas, for example, it was found that women with breast cancer experienced fewer troublesome symptoms and went for fewer cancer-related appointments in the months after doing expressive writing.

There is one area where the findings are more consistent and that is in the healing of wounds

The aim of the study wasn’t to look at long-term cancer prognosis, and the authors are not suggesting the cancer would be affected. But in the short-term other aspects of the women’s health did seem better than for those in the control group who wrote about the facts surrounding their cancer rather than their feelings about it.

But it doesn’t always work. A meta-analysis by Joanne Fratarolli from the University of California Riverside does demonstrate an effect overall, but a small one. Nevertheless, for an intervention that is free and beneficial, that’s a benefit worth having. Some studies have had disappointing results, but there is one area where the findings are more consistent and that is in the healing of wounds.

In these studies brave volunteers typically do some expressive writing, then some days later they are given a local anaesthetic and then a punch biopsy at the top of their inner arm. The wound is typically 4mm across and heals within a couple of weeks. This healing is monitored and again and again, and it happens faster if people have spent time beforehand writing down their secret thoughts.

Simply imagining a traumatic event and writing a story about it could have health benefits (Credit: iStock)

What does the act of committing words to paper do? Initially it was assumed this simply happened through catharsis, that people felt better because they’d let out their pent-up feelings. But then Pennebaker began looking in detail at the language people used in their writing.

He found that the types of words people used changed over the course of the four sessions. Those whose wounds healed the fastest began by using the word “I” a lot, but in later sessions moved on to saying “he” or “she” more often, suggesting they were looking at the event from other perspectives. They also used words like “because”, implying they were making sense of the events and putting them into a narrative. So Pennebaker believes that the simple act of labelling your feelings and putting them into a story is somehow affecting the immune system.

But there is a curious finding which suggests something else might be going on. Simply imagining a traumatic event and writing a story about it also makes wounds heal faster, so perhaps it’s less to do with resolving past issues and more to do with finding a way of regulating your own emotions that makes a difference.

Writing about your feelings doesn’t boost your immune system for life

After the first day of writing most people say that churning up the past has made them feel worse. Does the stress cause people to release stress hormones such as cortisol, which are beneficial in the short-term and could enhance the immune system? Or is it the improvement in mood after several days of writing that brings the benefits for immunity? So far, no one knows.

Whatever the mechanism, despite several decades of research showing it works, it’s rarely used clinically. You could imagine a situation where people booked in for surgery are given expressive writing instructions in the preceding weeks, but very few studies have used clinical populations with real, surgical wounds, rather than giving healthy students artificially-induced wounds. Also, it works better for some people than others, all depending on how well they engage with the process. What’s more, the effect is short-lived, so you’d have to get the timing just right. Writing about your feelings doesn’t boost your immune system for life. If the same people are wounded again a few months after an initial study, they don’t heal any faster than anyone else.

The writing could work after you're wounded - such as when you're healing after surgery (Credit: iStock)

But now new research from New Zealand suggests it’s not essential to do the writing before you are wounded. It can work just as well if you do the writing afterwards. This opens up the possibility of using expressive writing not just when surgery is planned, but for real-life injuries which of course we can’t predict. Kavita Vedhara from the University of Nottingham and her team in New Zealand took 120 healthy volunteers, and made them write about either a distressing event or how they spent the previous day. They did this either before or after a punch biopsy on their upper arm. The people from the expressive writing group were six times more likely to have a wound that had healed within 10 days than the people in the control group.

We’d need to have more studies conducted with real life patients, but maybe one day when we’ve had an operation, we might be told to go home with instructions on expressive writing. As Kavita Vedhara told me in the BBC’s Health Check, the effect is “short-lived, but powerful”.

October 1972, Hurricane Bebe Fiji.

October 1972, Hurricane Bebe Fiji. My first Typhoon or Hurricane relief operation. I was the IFRC 'Flying Squad ' member, the forerunner of FACT when they sent in one person to work with the affected national Red Cross Society. The New Zealand Government sent me in with a C-130 (Hercules plane) and a helicopter to do an assessment with Fiji Red Cross. An aerial assessment of the mainland (Veti Levu) and 70 remote islands was done in 3 days. Forty two years later I am working on the massive Typhoon Yolande (Haiyan) operation in the Philippines with an equally destructive Typhoon Ruby soon to make landfall. What have I learned in 42 years? Volunteers at community level is what it is all about, and that is the strength of the Philippine Red Cross. Good luck guys, I know you will deliver with passion, professionalism and dedication. A photo from 72 below, unloading NZ milk powder.

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Henrik Beer the great Red Cross leader

A very historic photo I unearthed yesterday of Henrik Beer Secretary General of the Federation IFRC, from 1960 to 1982. For those who knew most of the IFRC secretaries generals from 1930 to 1995, they unanimously agreed Henrik was the best we ever had. A committed humanitarian all his life, he perfected humanitarian diplomacy long before the phrase was coined. I was a cyclone shelter delegate in Tamila Nadu in 1980 to 82 when Henrik paid his last field visit before he retired in early 1982. Henrik is the balding man about to step into the car with a young Carl Naucler to his right after inaugurating one of the 233 cyclone shelters we built along the Andhra Pradesh and Tamil Nadu coastlines.  For more information on Henrik Beer, you can read on my blog: http://henrikbeer.blogspot.com/2011/11/memories-of-henrik-

Whither humanitarianism? Reflections on World Red Cross Red Crescent Day

by Mukesh Kapila, Professor of Global Health & Humanitarian Affairs, University of Manchester; Former Under Secretary General, International Federation of Red Cross and Red Crescent Societies

ICRC

Portrait of Henry Dunant

inShare5

Letter to Henry Dunant, father of the Red Cross, born 8 May 1828, died 30 Oct 1910

Dear Henry,
We commemorate your birthday today – 8 May - as World Red Cross Red Crescent Day. If you were alive now, you would be 186 years old. But you are not really gone. We remember you, everywhere and everyday. Everywhere - in the physical symbols and structures of your beloved creation, the Red Cross Red Crescent, scattered across neighbourhoods worldwide. Everyday – whenever someone extends a hand of friendship and compassion to a stranger in distress.
But who were you?
You never smiled during your lifetime. How could you – seeing what you did of the atrocities at the Battle of Solferino in 1859? In your own words:
"How many silent tears were shed that miserable night when all false pride, all human decency even, were forgotten!"
Today, you would be diagnosed as suffering from post-traumatic stress disorder (PTSD), and counselled or medicated out of your obsession to change the world. But you resisted and your smartness lay in recognising that the best way to disarm evil is by doing good. Would your dark brooding countenance in your endlessly reproduced portrait lighten a little knowing that two in every 1000 people in today's world volunteer for the Red Cross Red Crescent?
You were not afraid to speak truth to power as you coaxed and cajoled kings and generals into your universal Red Cross project. Your refusal to compromise on principles ensured solid foundations for international humanitarian law. If you had not stood firm, I wonder if the Geneva Conventions we know would have survived so many turbulent decades, or if we would have the conviction to negotiate them afresh today?
You were also remarkably resilient in the face of extraordinary opposition and abuse. Your own associates exiled you from your birthplace of Geneva and nearly succeeded in airbrushing you out of history. You suffered many long years in obscurity and poverty. But, much to your own bemusement, you were "re-discovered" at a convenient moment when a wounded world needed some feel-good do-good stories. Myth-making was thus your final service to humanity. This is important as your more feeble successors need constant injections of courage in the continued fight against stigma, discrimination, and myriad other social ills, hatreds and cruelties that plague our society.
And what of the Red Cross Red Crescent itself? Your original committee of five good men (from which your stubbornness got you thrown out) has transformed into national entities that cover 189 countries in what is now the world's largest humanitarian network serving over 155 million most needy and desperate people through some 16 million volunteers and 500,000 staff, and expending around US$35 billion annually.
And yet... are you satisfied? Perhaps you turn in your grave as you contemplate today's global humanitarian enterprise?
This is now a multi-billion dollar industry with thousands of brand-conscious humanitarian organisations competing in the marketplace of human misery. They employ hundreds of thousands of ambitious professionals for whom humanitarian work is a career track or sometimes, even a lifestyle choice. Humanitarianism has become a respectable academic discipline as researchers dissect its inner mysteries, policy-makers codify its workings, and trainers make a useful livelihood by inducting others into its complex rituals. It is also an indispensable tool for muscular governments vying with each other as they strut on the international stage. It is even a cool affair for film and rock stars to burnish their image by associating with it.
Do you fret that in an age of such amazing capabilities and immense resources, we have, arguably, lessening humanitarian access, even as needs and vulnerabilities from conflicts, crises, and disasters expand? Millions go cold and hungry in Syria, suffer barbarism in the Central African Republic, and endure genocidal assault in Sudan, to name just a few of the contemporary Solferinos.
The humanitarian corpus has metamorphosed but its soul has shrunk. We need you back to remind us that the humanitarian instinct – the urge to help others – is innate in all of us. It can be better tuned and guided, of course, but it cannot be squeezed into a neat corporate package. It needs to remain unruly, and always challenge our complacency. This is because the ultimate message of humanitarianism is that of permanent hope for a better world – by remaining dissatisfied and challenging everyone to do more, do better, and reach further. Just like you did.
So Happy Birthday, dear Henry. There can be no rest in peace for you, as your job is not done.

You can follow Mukesh Kapila on twitter @mukeshkapila.

Pakistan quake kills 45, creates new island

Thousands of Pakistanis ran into the streets praying for their lives late yesterday as a powerful earthquake rocked a remote area in the southwest, killing at least 39 people and possibly creating a small island off the coast.

The Pakistani military said it was rushing troops and helicopters to Baluchistan province's Awaran district, where the quake was centred, and the nearby area of Khuzdar. Local officials said they were sending doctors, food and 1000 tents for people who had nowhere to sleep as strong aftershocks continued to shake the region.

Most of the victims were killed when their houses collapsed, according to the chief spokesman for the country's National Disaster Management Authority, Mirza Kamran Zia, who gave the death toll.

He warned that the toll might rise and said the agency was still trying to get information from the stricken area.

"We all ran out for safety in the open field in front of our house. Many other neighbours were also there. Thank God no one was hurt in our area, but the walls of four or five houses collapsed," said Khair Mohammed Baluch, who lives in the town of Awaran, roughly 50 kilometres (30 miles) south of the epicentre.

Pakistan's chief meteorologist and the US Geological Survey put the magnitude of the quake at 7.7.

Pakistani officials were investigating whether the earthquake was so powerful that it pushed up the earth and formed a new land mass.

Witnesses reported seeing a small island appear off the coast of the port of Gwadar after the quake, said the director general of the Pakistan Meteorological Department, Arif Mahmood.

Gwadar Police Chief Pervez Umrani said people gathered on the beach to see the land mass, which was about 9 metres (30 feet) high and 100 metres (109 yards) long.

Baluchistan is Pakistan's largest province but also the least populated and most impoverished. Awaran district has about 300,000 residents.

Many residents are believed to be involved in smuggling fuel from Iran, while others harvest dates.

The area where the quake struck is at the centre of an insurgency that Baluch separatists have been waging against the Pakistani government for years. The separatists regularly attack Pakistani troops and symbols of the state, such as infrastructure projects.

A Pakistani military official speaking on customary condition of anonymity said security officials were fired on while escorting doctors to Awaran. No one was wounded.

The quake was felt as far as New Delhi, the Indian capital, some 1200 kilometres (about 740 miles) away, but no damage or injuries were immediately reported there.

The quake also jolted Pakistan's largest city, Karachi, roughly 250 kilometres (155 miles) from the epicentre. People in the city's tall office buildings rushed into the streets, and Pakistani television showed lights swaying as the earth shook.

"My table and computer started shaking. I thought I was feeling dizziness but soon realised they were tremors," Karachi resident Mohammad Taimur said.

People rushed out of their apartments and offices in Karachi. Photo: AP

In Quetta, the capital of Baluchistan, cellphone vendor Matiullah Khan said he was in his shop with a customer when the cabinet and shelves started to shake.

"I along with customers rushed out to the main street. ... Thousands of people were standing, many in fear and reciting Quranic verses," he said.

Baluchistan and neighbouring Iran are prone to earthquakes. A magnitude-7.8 quake centred just across the border in Iran killed at least 35 people in Pakistan last April.

Balochistan is Pakistan's largest but least populated province.

I worked for Red Cross/ Red Crescent in Pakistan for a number of years and travelled throughout Baluchistan and observed that most of the houses in villages and small towns are made from mud, wooden beams and rocks. Generally after quakes in this area, people can be trapped for some days in the rubble as rescue equipment is limited.

I wish all the rescue and relief workers every success in rescuing people and keeping people alive.

The impact of blogs 1.25 million hits.

Today I posted on Facebook and Twitter that my blog has received 1.25 million page views. As I write it shows me that it is now 1,251,942, so another 1942 page views in the last 8 hours. 

A former colleague and friend Mukesh Kapila wrote on twitter today in response to my claim " i clicked 10 times to make it 1.230,010. Congrats but In what way have u brought impact ? keen to learn." 

That is why I respect Mukesh because he is always the scientist,  analyzer and the advocate, and  challenges peers. Here is an answer Mukesh.

I started my blog in June 2007 while running the biggest ever disaster recovery operation, the Indian Ocean tsunami. I was seeing so many outstanding practices and models, and as many bad ones, in Indonesia, that I felt it a duty to share them and my lessons learned publicly. Sadly, international organisations in those days, were not responsive to personal and instantaneous feedback from their practitioners in the field. 

Blogging is a powerful tool for informing, promoting and persuading, and by persuading, it often means changing a person's life. In 2008 I had total knee replacements in both knees and scores of people thanked me as my personal testimony on my blog persuaded them to get their knees replaced and all feedback was positive. I thought at the time if you can persuade people to have two of their old knees carved out and replaced, what effect can blogging have upon 'changing minds?' 

Mukesh Kapila, in writing the International Federation of Red Cross and Red Crescent's Strategy 2020 (S2020), alludes to the weakness of our generation, a lack of leadership.

S2020 says, 

Our Leadership: We show leadership and strive for excellence in our work, drawing attention to the rights, needs 

and vulnerabilities of communities and the factors that 

underlie them. It goes on to list how to do it. 

ENABLING ACTION TO PURSUE HUMANITARIAN

DIPLOMACY TO PREVENT AND REDUCE

VULNERABILITY IN A GLOBALIZED WORLD

Our humanitarian diplomacy is concerned with persuading decision-makers and opinion leaders to act, at 

all times, in the interests of vulnerable people, and with 

full respect for our Fundamental Principles.

In a nutshell, my blog was set up in 2007 to share experience and lessons learned over four decades of humanitarian work. Yes, I wanted to positively influence people.

I love my humanitarian work at all levels, and I have an equal love for people, the mountains, the polar regions, books, rugby, experiential learning, family, travel, climate change and story telling. I write about every day life and share a lot. One of my early posting is about leaving New Zealand at the tender age of 19 for South America by sea - and falling in love in Tahiti with disastrous consequences - caused some censure from family members. http://bobmckerrow.blogspot.co.nz/2008/05/beginnings-part-2.html  But I did not care about the critics for I set out to write the truth, and constructively influence people to change the world. 

So to Mukesh and my friends, " In what way have I brought impact." People give you feedback through the comments section on the blog.

I have put up 975 posts, received 19,033 comments and I am able to see the most popular stories. But more importantly, if people have a life changing experience because of your influence, they seldom comment on it publicly, but contact you personally to share and discuss further. I have kept a record of such people that are in excess of 200. Companies such as Stryker, who make high tech artificial knees, have written to me saying how I have had a strong influence on persuading people to have total knee replacements.

When I arrived in Sri lanka in 2010, we had 20,000 Swiss Francs for our IDP programme. Today we have in excess of 90 million all up. In 2010 I started a targeted campaign on my blog begging for funding and can measure the feedback I received and the influence my blog had on fundraising.

Mukesh Kapila, by running on my blog the review written by Bill Nicol on your book ' Against A Tide of Evil' I know that for 2 weeks over 60 people were viewing it daily, but it has since dropped off.

I am also able to see that the majority of followers are from the US, France, UK, NZ, Australia, India, Japan, Canada, Poland, Romania, Indonesia, China, Russia, Germany, Sri Lanka, Malaysia, Pakistan and Italy. Small in number, but some of my most passionate followers are from the West Indies including Poet Laureate Patricia Hargreaves. 

Lyse Doucet and many of her colleagues from the BBC respond to comments I make and occasionally Helen Clarke, Head of UNDP give feedback. Writers such as Weston \DeWalt visit my blog and give comments, and many leading diplomats do also.  

I receive a lot of joy from the young people who visit, comment and write to me. Many are Red Cross volunteers who are inspired as are young mountaineers, explorers and wayfarers who seek guidance or advice. Way out front in popular postings is one on a 15 year old girl climbing Mt. Kilimanjaro with 1749 hits and 134 comments on 14 Oct 2011.  Sarah is the daughter of my friend Rob Hall, who tragically died on the summit of Mt. Everest in 1995, one month before she was born.

An interview with Sandra D'Urzo from the IFRC shelter department in Geneva was also very popular with 199 people visiting and leaving 49 comments. She spoke on PASSA, and settlement planning.

One comment that floored me recently was from Jeff Blumenfeld who runs a leading New York PR company and is editor of  the veru popular Expedition News who wrote to me saying " I get more referrals from your blog to Expedition News than any other." Neither of us could believe it but the facts are there.

In two weeks time my local mountaineering club in Otago, New Zealand is celebrating 90 years and the article I wrote some months ago is running hot.

Mukesh and friends, I could go on until daybreak which is 2 hours away, but feel this is enough. Blogs, like well-written books, are hugely influential. Their readers are sharp and unforgiving at times, and that is why total openness and honesty is essential because readers quickly pick up insincerity and will drift away at a whiff of it.

A million page views today. Thank you.

Today I reached that magic total of 1 million page views on my blog. Thanks to Howard Arfin for helping, inspiring, demanding I set up a blog in 2007. He was so right saying that leaders in the Federation  (IFRC) should be giving their opinion to help engender more support for the poorest of the poor. Here are the stats from the counter a few minutes ago:

Pageviews today
2,455
Pageviews yesterday
4,309
Pageviews last month
129,648
Pageviews all time history
1,003,232

And what are the most popular ones in a day?

Entry Pageviews
Rob Hall's daughter Sarah climbs Kilimanjaro at 15...
14 Oct 2011, 80 comments
888 hits
A Master of the Mountains - Nicholas Roerich
11 Feb 2011, 212 comments
429 hits
Off to Minnesota next week for our North Pole Expe...
3 May 2011, 61 comments
389 hits
Khalil Dale, a few thoughts on a Red Cross colleag...
30 Apr 2012, 168 comments
363 hits

Horn of Africa Drought, Why does it keep happening...
15 Jul 2011, 2 comments
197 hihitsts

A detailed description of the Hindu Kush and other...
14 Aug 2010, 70 comments
196 hits

Keith Murdoch mystery. Remember that day NZ vs Wa...
24 Nov 2012, 20 comments
186 hits

107 grueling games in 18 months: 1888-89
17 Jun 2011, 176 comments
184
Hotel bombings in Jakarta
17 Jul 2009, 55 comments
157 hits
Christchurch two years on after the earthquake
21 Feb 2013, 44 comments

Thanks to all of you who have visited by blog; commented, debated, disagreed and unabashed, advertised. I love you all. I have been enriched by your participation.

Interview with Sandra D'Urzo - Senior Shelter Officer at IFRC Geneva.

Sandra D'Urzo IFRC (right) and Jaime Royo-Olid EU (left) two experienced shelter and settlement experts at a PASSA workshop in Colombo last week. Photo: Bob McKerrow

Delighted to have Sandra D'Urzo from the International Federation of Red Cross and Red Crescent Societies headquarters in Geneva visit the north of Sri Lanka in the past two weeks. Have a look at her interview on Shelter, Settlement and PASSA.

A permanent house with a transitional shelter attached to the rear in Aceh Indonesia. Red Cross built 20,000 transitional and 20,000 permanent houses after the Asian Tsunami. Photo: Bob McKerrow

Graham Saunders gives an introuduction to PASSA

Shelter and settlement risks and vulnerabilities are on the
increase due to changes in disaster trends, the impact of climate
change, as well as growing social and economic marginalisation
and urbanisation. At the same time, institutional resources to
support safe and adequate housing are declining because of
global financial constraints, the move towards smaller, less
interventionist government, and the scale of the challenges
faced. Households and communities that were previously able
to safeguard their lives and assets using their own resources
and know-how are increasingly finding that the type, scale and
frequency of the hazards they are now being exposed to pose a
severe threat to their safety and well-being.
Major disasters often, but not always, generate sufficient funding
for the required reconstruction and recovery. This can promote
the need to ‘build back better’; however, this is the exception.
With disaster trends indicating a move towards more frequent
small and medium-scale emergencies, the majority of households
affected by such localized disasters have to draw upon their own
limited resources, and invariably rebuild the same vulnerabilities.
There is no active presence to promote better practices in
mitigation and limited or no financial or technical support to
incorporate sustainable approaches to building resilience. What
can be done in such contexts, with unlimited needs but very
limited external resources?

A participatory approach to safe shelter awareness (PASSA)
aims to raise the awareness of the ‘everyday vulnerable’ of the
‘everyday risks’ related to their built environment and foster
locally appropriate safe shelter and settlement practices. It
offers a simple process, facilitated by the Red Cross Red Crescent

volunteers and technical advisors, through which communities International
Federation of Red Cross and Red Crescent Societies can build upon
 their own insights, skills and leadership to attain
improved living conditions and safer habitats.

Community participation is a crucial factor to success. here is a grievance meeting in Mannar Sri Lanka where people have a chance to discuss about those who got houses, and those who missed out.

Using a step-by-step methodology, PASSA utilizes three
complementary processes. Firstly, it harnesses the established role
of the National Societies to support community-led and socially
inclusive development activities. Secondly, it enables communities
to identify their own solutions and realistic and comprehensive
strategies for addressing the myriad of problems that include
spatial and environmental planning, local building cultures and
the effectiveness of local construction techniques. Thirdly, it
fosters partnerships between local authorities, communities and
supporting organizations to prepare for, cope with and recover
from disasters.
The expertise of construction specialists is needed throughout
the process, to respond to technical issues arising and to help
manage the expectations of communities and households on
modifications to houses and the surrounding settlement. These
professionals work collaboratively with social mobilizers to
promote awareness, bring coherence to the risk-management
efforts and ensure the technical performance of the safe shelter
and settlement solutions identified.
PASSA draws upon the well-established practice of community
action planning, and the participatory hygiene and sanitation
transformation (PHAST) methodology used by many National
Societies. With IFRC’s vulnerability and capacity assessment
(VCA) to provide an overall analysis of a community’s needs
and assets, PASSA is the participatory tool to comprehensively
identify and safeguard against shelter and settlement risks.9
International Federation of Red Cross and Red Crescent Societies
Foreword Participatory Approach for Safe Shelter Awareness
The use of PASSA valuably informs both individual and
community understanding of vulnerability related to the built
environment, and leads to the identification and promotion
of locally appropriate measures to achieve safer shelter and settlement.

Reflections on the ICRC’s present and future role

Reflections on the ICRC’s present and future role in addressing humanitarian crises.

Volume 95 Number 889 Spring 2013 International Review of the Red Cross

Matthias Schmale, Under Secretary General of

National Society and Knowledge Development at the

International Federation of Red Cross and Red Crescent

Societies

Matthias Schmale is Under Secretary General of National Society and Knowledge Development at the International Federation of Red Cross and Red Crescent Societies (IFRC). During his career with the International Red Cross and Red Crescent Movement, Mr Schmale has also served as IFRC Under Secretary General for Programme Services and as IFRC Under Secretary General for Development, and International Director at the British Red Cross from 2005 to 2009.

While writing this opinion note about the International Committee of the Red Cross (ICRC) on the occasion of its 150th anniversary, I fondly remembered many encounters with ICRC colleagues over almost twenty years. During numerous field visits to hugely challenging environments, such as Darfur or Afghanistan under the Taliban regime, I have been privileged to witness the ICRC as an action-oriented agency that delivers humanitarian aid. Around the globe there are countless people who will tell you with deeply felt gratitude how the ICRC has saved their lives and helped them cope with immeasurable suffering caused by armed conflicts and violence.

An important factor making the ICRC a credible, neutral, and independent actor is its competent and dedicated staff members. Like for so many humanitarian agencies, perhaps the biggest asset for the ICRC– apart from international humanitarian law providing the legal basis for its action, and the protective power of the emblem– is its people. Having got to know a considerable number of ICRC staff over the years, I can testify that, for many of them, working for the ICRC is more than a job: in an almost religious sense, they are committed and totally passionate about what they are doing for the cause of humanity. I remember vividly a cooperation delegate explaining with conviction and credibility many years ago to several Federation colleagues, on a hot evening somewhere in the field in Africa, how the ICRC is ‘an organization I would die for’.

The ICRC has come a long way from being a very Swiss, male-dominated organization to being multinational and more gender balanced in its staff composition. Even some years ago, the ICRC’s Director of Operations stated with pride in talks with British government representatives and the British Red Cross in London that among the 200 or so expatriate staff working in the then Sudan, the ICRC had almost fifty different nationalities represented.

For the ICRC, access to the most vulnerable people – often in places that others cannot reach– is based on NIIHA, neutral, impartial, and independent humanitarian action. It was particularly during a visit to Darfur that I understood how much effort the ICRC puts into maintaining dialogue with all parties to a conflict in order to ensure access to people in need. If I remember correctly, at one point there were– apart from the Sudanese national army – at least eighteen armed factions on the ground in Darfur, with all of whom the ICRC maintained regular and professional dialogue.

The NIIHA approach is often misunderstood as the ICRC not caring about and closing its eyes to injustices. In this regard one of my lasting memories is of a panel discussion in Nairobi in the mid-90 s looking at how to deal with alleged perpetrators of the Rwandan genocide living amongst the numerous refugees housed in camps in north-western Tanzania. The event was organized to discuss the implications of a Médecins Sans Frontières (MSF) report suggesting that ‘humanitarian relief organizations may well be forced to halt their humanitarian relief activities’ due to the deteriorating security situation in the camps. During the panel  discussion the ICRC’s regional head of delegation eloquently outlined that neutrality does not mean sitting on the fence, and that in fact the ICRC always takes the side of the most vulnerable. He went on to explain that as long as the Red Cross and Red Crescent could reach the majority of people in desperate need of support it would and should stay and carry out its humanitarian work. He acknowledged the presence of people in the camps who had allegedly committed horrendous crimes against humanity, but insisted that it is not the job of humanitarians but of the police, the military, and governments to hunt down criminals and those violating international humanitarian law (IHL).

At the beginning of my own humanitarian journey, another ICRC colleague explained to me that working for Red Cross or Red Crescent ‘you need to be prepared to do business with devils’. When visiting Taliban-ruled Afghanistan I experienced what this meant in practice: without any doubt the leadership of the Afghan Red Crescent at the time was closely linked to the Taliban regime, and this was hard to stomach for even the most seasoned Red Cross or Red Crescent workers. At the same time, maintaining dialogue and relations with the Taliban and the leadership of the Afghan Red Crescent allowed the ICRC and its Movement partners to reach hundreds of thousands of Afghan people – including very vulnerable women and children– and deliver life-saving and dignified humanitarian aid.

Staying focused on action does not mean that the ICRC shies away from controversy and from trying to influence opinion leaders and decision-makers. In 2007, the ICRC stopped its humanitarian work in Myanmar and publicly criticized the authorities for not giving it the humanitarian access it needed to be effective (the ICRC has since resumed its activities there). Much of its influencing or advocacy work happens away from the public limelight and is thus insufficiently appreciated.

An example of this is the work the ICRC has been carrying out behind the scenes to work towards more acceptable conditions in prisons for those detained as a result of armed conflict and political disagreement. The ICRC’s detention delegates are unsung heroes. When they were released from their long captivity under the apartheid regime, Nelson Mandela and other anti-apartheid activists acknowledged that receiving visits from ICRC detention delegates were a lifeline to the outside world and an important part of surviving with their sanity intact.

What does the future hold for the ICRC?

Having expressed all these fully meant compliments about what the ICRC does andwhat it represents, the question is whether it will likely stay this way. We have to acknowledge that neutral, impartial, and independent humanitarian action is increasingly under threat, and not just in very recent times. In June 1996 I was working with the Federation’s regional delegation in Nairobi –home to a big ICRC base –when the tragic news of ICRC delegates being targeted and murdered in Burundi came through. This profoundly shook friends and colleagues in the ICRC, not least as this was followed a couple of months later – in December 1996 – by the similarly murderous attacks on ICRC delegates in Chechnya. The ICRC’s privileged access to vulnerable people in armed conflict and situations of violence suddenly seemed threatened by the proliferation of armed groups that did not understand or accept international humanitarian law, that were driven by a profound disrespect and disregard for humanity as well as a sense that an organization that has its roots in the West could not be truly neutral.

The ICRC leadership has understood that the world is changing rapidly and that the ICRC needs to adapt – potentially quite radically – if it wants to stay relevant. One of the reasons why the ICRC has increasingly focused on its operational partnerships with National Societies is the realization that access to sensitive conflict situations could no longer be guaranteed by relying on its own expatriate staff and its own relations with the respective national and local authorities. For a number of years now, the ICRC has been investing considerable resources into what it calls ‘cooperation with National Societies’. There are many examples in places like Afghanistan or Palestine where successful delivery of the ICRC’s humanitarian services is made possible through the network of National Society volunteers and staff.

A legitimate question is whether the ICRC is instrumentalizing National Societies for operational survival reasons. I share the perception that there is some ‘institutional arrogance’ in the ICRC– deriving from its size and impressive track record – and that it will take time to fully weave into its DNA how to evolve its relationships from that of a donor with National Societies as its delivery organizations to equal and fully transparent partnerships.

There are also inherent limitations to what an organization with an international global mandate can operationally transfer to national organizations.

As local actors, National Societies will continue to face conflict and war situations where they –with the best intentions –will not be able to provide fully neutral and independent humanitarian services to affected people. In such situations the responsibility for humanitarian action will likely continue to be with the internationally recognized neutral actor, namely the ICRC.

As it prepares itself for the future, the ICRC appears to be struggling to redefine its role and added value in the context of being part of a larger Red Cross and Red Crescent Movement. The ICRC’s President and Director General have publicly stated that we have to acknowledge that in the outside world we – that is ICRC, National Societies, and the International Federation– are seen as one and that we have no choice but to work together. Some in the ICRC see it asessential to fully embrace the Movement, as well as to further diversify its portfolio in order to, for instance, include and/or broaden the scope of its operational work to other situations of violence and to diversify its developmental action (e.g. in livelihood protection and agriculture), organizational development, and capacitybuilding. Others advocate for remaining focused on preserving and strengthening the ICRC– almost irrespective of what goes on in the rest of the Movement – and staying as close as possible to its original mandate. Former President Kellenberger clearly expressed this view when I heard him state a number of times that his job was to be President of the ICRC and not of the Movement. He saw National Societies and the Federation as privileged, but not exclusive, partners of the ICRC.

From my perspective, the Red Cross and Red Crescent Movement will stay strong and relevant if all three – ICRC, National Societies, and the Secretariat of the International Federation–have a constructive dialogue about what the future might bring and what adjustments or changes will have to happen. A conventional view is that we have to keep all three components as healthy organizations, each delivering distinct services and value. And, not least of all given the tightening of financial resources, we will have to, at a minimum, avoid duplication as much as possible, provide our services in the most (cost-) effective manner and ensure that we each offer something unique and complementary. From this perspective, there are grounds to caution the ICRC not to give in to what is called ‘mission creep’ by further diversifying its activities. While modernizing and adapting, the ICRC would be well advised to stick to its roots by remaining the international humanitarian organization of choice for neutral, impartial, and independent response in times of conflict and violence, giving a lifeline to humanity for prisoners and remaining the guardian of international humanitarian law.

A more ‘out of the box’ view would suggest that what is described in the previous paragraph amounts to ‘fiddling while Rome is burning’, and that we need to be more brave and daring in jointly designing a future architecture for the Movement. This approach could entail anything from merging the two international components of the Movement (especially if they were to end up doing more or less the same) to redefining what each one should be doing. It would come with a zero tolerance for duplication by, for instance, having only one of the international organizations carry out operational work and the other – standard-setting and  maintaining the joint values and principles base.

Regardless of which one of these scenarios turns out to be more feasible and appropriate, the ICRC should not rest on its well-deserved laurels. If it wants the Movement as a whole to be strong and relevant, it will have to move beyond defending its own institutional interests and agreements outlining roles and responsibilities, such as the one reached at the Council of Delegates in 1997 in Seville. The ICRC should continue to identify and implement the mindset and organizational culture changes that will ensure that at its next major anniversary, it will receive similarly positive feedback on its role and performance as can be found in this edition of the International Review of the Red Cross.

A 150 years after a noble idea was turned into a humanitarian institution by the vision of one man, Henri Dunant, it is time to celebrate,  reflect and learn. 

  The wide array of quality work done by ICRC over 150 years is truly remarkable, and having 
187 national RC and RC societies around the world to work with, clearly exceeded Dunant’s dream when he wrote: 
  “ Would it not be possible, in times of peace and quiet, to form relief societies for the purpose of having care given to the wounded in wartime by zealous, devoted and thoroughly qualified volunteers?”   Dunant was the dynamo of our world-wide RC movement, and we must honour all those zealous, devoted and thoroughly qualified volunteers and staff, who have given their time, many their lives, over 150 years, to serve and alleviate human suffering.   The ICRC, with the Federation and its member national societies, are all key components of evolving humanitarian action with a reach to those tragic  ‘storehouses of sorrow world-wide.’ 
   To take this ideal  further, Nicolas Bouvier, a Swiss writer and artist wrote, “ My belief is that one must have passed through fire oneself....to be able to sort out...the contents of those storehouses of sorrow, where fortunately we can also find, more often than we might have dared to expect...enough small miracles to motivate and encourage those in the field who are so often compelled, to quote a medieval Japanese poem, ‘to bear the unbearable and tolerate the intolerable.”   On behalf of the International Federation we thank and congratulate  the ICRC for its brilliant  humanitarian work over 150 years which has provided hope and succor in times of despair and helped so many victims to build new lives.

Written by Bob McKerrow head of delegation, International Federation of Red Cross and Red Crescent Societies, Sri Lanka for the ICRC publication on 150 years of humanitarian action. 

On 17 February 1863 five Swiss citizens gathered in Geneva to create an international committee for relief to the wounded, which in 1875 was renamed the International Committee of the Red Cross. The ICRC is now one of the largest international humanitarian organizations, with almost 13,000 staff working in behalf of the victims of armed conflict and other violence in 92 countries.The activities of the ICRC and of the entire International Red Cross and Red Crescent Movement began on fields of battle, where wounded soldiers were cared for no matter who they were or which side they belonged to.

The Red Cross story that began 150 years ago is not only the story of the Red Cross itself – it is also, in fact mainly, the story of people who suffer the effects of war and other violence, and of what can and should be done to help them.

150 years of humanitarian action in the midst of armed conflict

14-02-2013 News Release 13/16

Geneva (ICRC) – On 17 February, the International Committee of
 the Red Cross (ICRC) will mark its 150th anniversary and
commemorate the beginning of its efforts to bring relief to
millions and improve the lives of countless people adversely
affected by armed conflict.

At a time when people are suffering the agonies of war in Syria, Mali, the Democratic Republic of the Congo and
 elsewhere, the ICRC is more determined than ever to carry on with its humanitarian mission.

"This anniversary provides us with an opportunity to look critically at our past, and also to develop awareness of the 
strengths that have helped us in our activities carried out for millions of victims of armed conflict and other violence," 
said Peter Maurer, president of the ICRC. "Now more than ever, we must not only remain true to our principles but also
 search for new ways to better serve the people who need help. We must redouble our efforts to make sure that the 
neutral, impartial and independent nature of our humanitarian activities is understood by all."

"Together with our partners within the International Red Cross and Red Crescent Movement and the broader 
humanitarian community, we must seek ways of meeting these challenges," said the ICRC president. "We have to
 better coordinate humanitarian efforts, and pay very careful attention to the opinions of those we are seeking to help
 – and give them the opportunity to play an active role in these efforts, the ultimate aim of which is to enable people
 in need to achieve a lasting recovery.''The ICRC continues to adapt to new forms of armed conflict and to a number of 
challenges confronting humanitarian activities. "We are carrying on with our work in an environment that is being 
shaped 
by the use of new weapons and technologies, the proliferation of armed groups, the difficulty of obtaining access to 
people requiring aid, and a plethora of NGOs and other humanitarian organizations endeavouring to serve communities
 with competing approaches," said the ICRC president.

The biggest challenge facing the ICRC and other humanitarian organizations is a lack of respect for international 
humanitarian law, which prohibits violence directed against people who are not involved in armed conflict, like children, 
the wounded or sick, or detainees. "The need for a strong political will to spare civilians and otherwise comply with 
international humanitarian law, whether on the part of States or of non-State armed groups, has never been greater," 
said Mr Maurer.

Many of the ICRC's everyday activities now have far-reaching effects.

 "When ICRC delegates visit detainees in Guantanamo, or facilitate the 
release of hostages in Colombia, or help people in Afghanistan obtain health 
care in safe conditions, or provide the maintenance and technical know-how 
that keep the water and electricity networks up and running in Goma, a city of
 half a million people, or push for a binding international treaty on cluster 
munitions, they have a direct and lasting impact on the lives of many people,"
 said Mr Maurer.

"The vision of Henry Dunant – the Red Cross idea – has not only survived 
but flourished through all these long years," said Mr Maurer. "Over the past 
century and a half, the ICRC has overcome political adversity, financial difficulty, 
cultural barriers and countless other obstacles, even attacks on its own staff to 
bring vitally needed humanitarian assistance and protection to people in need." 
Once quite small with an entirely Swiss staff, the ICRC now performs its 
humanitarian tasks in over 90 countries all over the world, and has a workforce 
of almost 13,000 men and women of over 100 different nationalities.

Photos: Bob McKerrow